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DIABETES TYPE 1 - INSULIN DEPENDENT DIABETES

What is Diabetes Type 1 ?

The word diabetes comes from a Greek expression meaning syphon . It refers to the large amount of urine and the excessive thirst which often occurs in newly diagnosed or uncontrolled diabetes. However, in the early stages there may be no symptoms at all. The main symptoms are due to a build-up of glucose (sugar) in the bloodwhich overflows into the urine. The glucose draws water with it, and produces more urine. In turn the body s fluid reserves are reduced and this causes thirst, cramps, tiredness, weakness, weight loss and sometimes severe dehydration. A failure of the body s defence against infection can result from the raised glucose levels in the body. This can produce skin infections like boils or recurring urine infections. In some countries, tuberculosis is the first sign that someone has diabetes. If the levels of sugar in the blood are particularly high and prolonged, a condition called ketoacidosis can occur. This leads to shortage of breath and even coma.

How does Diabetes Type 1 occur ?

This type of diabetes is due to an almost complete lack of insulin, an important hormone that comes from the pancreas gland (sweetbread) which lies just beneath your liver in the upper abdomen. In non-diabetic people, insulin holds down the glucose level in the blood to a level between 4 and 9 millimoles per litre (mmol/l) (70 – 160 mg/dl) by helping the body's cells to use the glucose as fuel. In your case, lack of insulin allows the blood-glucose level to go much higher than this,producing the symptoms listed above. A rise of glucose in the blood can trigger other chemical reactions in the body. These can cause damage to blood-vessels and nerves in the long term.

Why does Diabetes Type 1 occur ?

There is an inherited element to this type of diabetes which predisposes the pancreas to damage from a number of possible agents : the exact genes have not yet been identified. Certain virus infections are thought to set off a destructive process in the pancreatic cells which make insulin, but only in susceptible people. This so-called auto-immune reaction is probably the main process leading to type 1 diabetes.Too much alcohol can also damage the pancreas.

Treatment Involved for Diabetes Type 1

Urine, or ideally blood needs to be tested at least once daily at different times, and recorded in a booklet for your doctor to see at every visit. Special strips make finger-prick blood-testing easy. It is a more accurate assessment of control. Inexpensive meters are available to give you a digital read-out of blood-glucose level. Adietitian should advise you about your special dietary needs . The principles are to reduce sugar and sweet foods,cut down on fats and fried foods, and build up fibre. It is important to follow diet carefully. Insulin is available in many forms but currently must always be injected using a syringe or a pen injector. Insulin cannot be absorbed through the intestine. Inhaled insulin may prove a practical alternative, but is not yet a substitute for injections. Human (synthesized) insulin has no major advantage over pork insulin. The action of regular (soluble, clear) insulin lasts 6 to 10 hours. Linking insulin to certain proteins (cloudy insulins) prolongs its action to12 to 32 hours. Various mixtures of insulins given twice aday often allow quite good control. Giving soluble insulin before main meals, with a long-acting insulin once or twice a day often gives the best control and a lot of flexibility. Portable or implantable insulin pumps, which feed insulin directly into body tissue are suitable for the occasional patient. Certain tablets may be given to you to improve control of the diabetes. These are biguanides or glitazones. They help the insulin to act more efficiently, However, tablets alone are never sufficient to control thjis type of diabetes in the long term. Transplantation of the pancreas or the islets within the pancreas is increasingly being used in some centres, particularly if kidney transplantation is also being performed.

During Treatment for Diabetes Type 1

Your blood glucose level should be kept below 10 mmol/l (180mg/dl) at most times, and ideally between 4 and 7 mmol/l (70 to125 mg/dl) before meals. If urine testing, negative tests are desirable, but this is not really a satisfactory way of assessing control. Above age 60, it may be wiser for some patients to allow sugar levels to run a little higher. The doctor will arrange special blood tests from time to time (haemoglobin A1, HbA1c or fructosamine). The HbA1c in particular provides a very good idea of your blood sugar control over the previous 10 weeks or so. In most laboratories, an HbA1c below 7.0% indicates good control (people without diabetes have levels below 6%). A value consistently above 8% indicates that you are risking damage to nerves and blood vessels long term. An important study (called the DCCT) has shown how important blood glucose control is for reducing the risk of complications in your type of diabetes. If blood glucose falls below 3 mmol/l, symptoms of low blood sugar (called hypoglycaemia) may occur. This results in sweating, shakiness, hunger, confused feelings, and even unconsciousness. Reduced or missed food, too much insulin, or exercise cause this problem. Always keep sugar in some form in your pocket or pursefor immediate use. Stress of any type (emotion, infection, accident) raises glucose levels and calls for a higher insulin dose. If glucose levels run too high, the original symptoms of diabetes return. If allowed to continue further, urine ketones (tested by special strips called Ketostix) can develop due to excessive fat breakdown into keto-acids. This is the warning sign of keto-acidosis (diabetic coma). Contacting the doctor is then both essential and urgent. Keto-acidosis produces a feeling of nausea, sometime with vomiting, and this can be easily confused with a tummy bug. Shortness of breath develops, and the breath may smell sweet, due to its content of acetone. Drowsiness develops quite quickly if not treated quickly, and coma may result. Wearing an identification (bracelet or pendant) is therefore always advised. This is also useful in case of accident or a bad insulin reaction.

After Treatment for Diabetes Type 1

After several years, the eyes, kidneys and nerves may be affected by blood-vessel changes. Sustained raised glucose levels in the blood can lead to these blood-vessel abnormalities and bleeding in the retina of the eye (diabetic retinopathy). The retina of your eyes will be checked with an ophthalmoscope every year, ideally after drops to widen your pupils. You may need to remind your doctor to do this! An eye doctor may need to give special laser treatment to treat retinopathy. Feet are important: nerve damage can result from poorly controlled diabetes, and this can cause numbness and interfere with the ability to feel dangerous objects or cuts. Any infection or cut needs to be treated quickly and carefully. Any self-treatment of the feet or toenails should be first discussed with your doctor; particularly in later life, it is best performed by a chiropodist. Good footwear is essential. You should avoid walking barefoot. Impotence may also occur from nerve damage, and this can be successfully treated in a number of ways. Other complications of diabetes may occur after several years. Hardening of the arteries affecting the legs (which cause calf pain), the heart (causing angina) is and the brain (causing stroke) is more often a problem in longstanding diabetes. Smoking increases the risk of these problems: therefore no diabetic should smoke. A complete physical check-up and blood test are advised at strict yearly intervals to be sure that all is well. Keep an eye on blood pressure; this can be raised due to kidney involvement from diabetes. Keeping blood pressure at or below 130/80 has been shown to prevent further kidney damage, and reduces the risk of stroke and heart attack. You may need to take regular tablets to lower your blood pressure. Control of blood pressure is probably just as important as blood glucose in the longer term. Rarely, people may need treatment with an artificial kidney or a kidney transplant. Your doctor will check the levels of cholesterol and other blood fats from time to time. Limiting certain foods and taking extra tablets are sometimes necessary to lower these blood fat levels. Keeping them normal reduces the risk of heart attack, and probably stroke and leg artery problems as well. You may be prone to other so-called auto-immune disorders: particularly the thyroid gland can be affected in as many as 10% of people with diabetes. Your doctor will probably check this from time to time.

If Diabetes Type 1 is Left Untreated

Coma occurs when blood glucose levels remain elevated, especially when encountering some form of stress. It is important to remember that diabetes can be poorly controlled, without you having any symptoms at all. This highlights the importance of regular blood glucose testing Raised blood glucose levels cause damage to tissues in the body, particularly the eyes, kidneys and nerves. The closer that your glucose levels are to normal, the less likely these complications will be to develop.

Effects on Family of Diabetes Type 1

A diabetic diet is a healthy diet suitable for other members of the family. People in frequent contact with you need to know the symptoms of hypoglycaemia (hypo) because sugar may need to be given. Glucagon (given by injection) is useful for treating severe hypos. Living with diabetes can be stressful, and those close to you need to understand this.